Adrenaline and the Inner World: An Introduction to Scientific Integrative Medicine

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JHU Press, Apr 1, 2008 - Medical - 328 pages
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This accessible work is the first in more than seventy-five years to discuss the many roles of adrenaline in regulating the "inner world" of the body. David S. Goldstein, an international authority and award-winning teacher, introduces new concepts concerning the nature of stress and distress across the body's regulatory systems. Discussing how the body's stress systems are coordinated, and how stress, by means of adrenaline, may affect the development, manifestations, and outcomes of chronic diseases, Goldstein challenges researchers and clinicians to use scientific integrative medicine to develop new ways to treat, prevent, and palliate disease.

Goldstein explains why a former attorney general with Parkinson disease has a tendency to faint, why young astronauts in excellent physical shape cannot stand up when reexposed to Earth's gravity, why professional football players can collapse and die of heat shock during summer training camp, and why baseball players spit so much.

Adrenaline and the Inner World is designed to supplement academic coursework in psychology, psychiatry, endocrinology, cardiology, complementary and alternative medicine, physiology, and biochemistry. It includes an extensive glossary.

 

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This remarkable book is both accessible to the layman, and should be required reading for physicians. It delivers so much more than what the title promises, in that it is really a philosophical treatise on how medicine should work, based on an insightful appraisal of how the body and the mind maintain "homeostasis", or steady-state operation. For anyone who has questioned the fairly narrow focus on adrenal steroids that occupies clinical endocrinology, it is a revelation to see how crucial the other adrenal hormones, especially adrenaline, are to the harmony of both the body and the mind. Dr. Goldstein teaches that control of basic body functions as well as some aspects of mental states is accomplished by dynamic, complex, interdependent feedback loops that often cross any putative body/mind boundary. He delineates the key control systems, explaining along the way how they can affect multiple biological variables, influence mood and behavior, and interact with each other. Dr. Goldstein gives a wonderful historical perspective, teaching that human understanding (and sometimes tragic misunderstanding) of all of this has evolved over thousands of years, and that the way this understanding evolved impacts patient care today. In an era when practitioners too often resort to diagnoses of convenience in order to dismiss patients whose complaints are complex, an honest reading of this book by physicians should provide scientific support in finding better ways to help. For the patient with a disability such as autonomic failure this book could be like food to a starving man, holding out hope that a careful analysis of the dynamic response of these control systems could yield at least an insight into the cause of the disability, if not also an effective treatment. Using extremely engaging and entertaining writing, fascinating references to the Bible, biographies of historical figures in medicine, and clever but simple analogies Dr. Goldstein makes the complex immediately intuitive. But, what is truly amazing is the economy with which he disposes of certain philosophical mistakes that even now distort patient care, especially the notion of body-mind duality championed by Descartes. He does a superb job of arguing against the still widely accepted idea that the mind and the body are somehow separate, only connected by a one-way street where affectations of the mind cause physical illness, while the reverse is rarely the case. In fact, as a philosophical treatise on medicine the book really packs a punch in terms of the sheer territory that it so accurately covers. For such a readable book, this is a real accomplishment.
For anyone interested in how the body controls its basic functions, what can and does go wrong, a solid introduction to the idea of feedback loops, and the definition and medical implications of stress, this book really stands alone. As a vision for how medicine should be it shines a bright light in corners where much ignorance still lurks
 

Contents

The Inner World
1
The Seed and the Soil
4
Cannons Canons
5
The Comfort Level in Building 10
8
An Amazing Cooking Experiment
12
Death by Football
14
The Sleeper Hold
16
Snakes That Faint?
18
Distress versus the General Adaptation Syndrome
150
Fight Isnt Flight
151
The Nose of God
158
StressToons
160
Stress in Evolutionary Perspective
164
Darwin and Ethology
169
The Price of Complexity Is Eternal Stress
172
Primitive Specificity
176

Rules of the Game
21
Same Difference
27
The AllDay Sucker
29
The Automatic Nervous System
30
Transformers
35
Good Housekeeping
40
The Hot Line
45
The Arbiters of the Inner World
57
On the Risk of Being a Physicians Son
58
Whats in a Name?
59
Catecholamines Look Like Cats
62
Adrenalines Effects on the Body
64
Neuronal Soda Pop
79
The Getaway Car Analogy
91
The Atavistic Catecholamine
93
First I Secreted a Hell of a Lot of Adrenaline
95
A PlayDoh Model of the Brain
101
The Nobel Chemicals
103
The Rest of the Cast
106
The Axis Powers
107
The Water Works and Kosher Pickle Treatment
110
Salt Sense
113
Your Own Brand of Morphine
115
Cytokines
117
Sex
118
Leptin
119
Stress as a Scientific Idea
121
Stress Response Patterns
129
Distress
141
Biblical Lie Detection
148
Dysautonomias
181
The MindBody Problem
182
Primary versus Secondary Dysautonomias
184
Secondary Dysautonomias
185
Primary Dysautonomias
194
Tests for Dysautonomias
207
Physiological Tests
209
Neuropharmacological Tests
215
Neurochemical Tests
220
Neuroimaging Tests
222
Treatments for Dysautonomias
224
Drug Treatments
229
Drugs and the Family
235
Legal Addictions
236
Cocaine
240
Morphine
242
You Arent What You Eat Luckily
243
The Future Scientific Integrative Medicine
247
Return of the Getaway Car
248
Allostatic Load for People Who Hate Snakes
250
The Dialectic
254
Darwinian Medicine
259
Tactics and Strategies of Scientific Integrative Medicine
263
What How and Why
266
Conclusion
269
Glossary
271
References
293
Index
295
Copyright

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About the author (2008)

David S. Goldstein, M.D., Ph.D., is an attending physician at the Clinical Center, National Institutes of Health, and a senior investigator at the National Institute of Neurological Disorders and Stroke.

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